Pharmacy Services

pharmacy searchable CenCal Health Pharmacy Services provides a comprehensive pharmacy benefit that includes formulary management, a robust pharmacy network, and quality customer service. Our pharmacy network spans both Santa Barbara and San Luis Obispo Counties providing our members with convenient pharmacy locations.

Pharmacy Benefit Manager

CenCal Health has contracted with MedImpact as its Pharmacy Benefit Manager (PBM) to assist in the administration of our pharmacy benefit.

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MedImpact provides: 

  • Claims processing
  • Pharmacy network management
  • Prior authorizations
  • Customer service
  • Drug utilization management services

CenCal Health Pharmacy Team shall oversee MedImpact’s administrative and daily operational role. To contact MedImpact, call: (800) 788-2949.

Our Promise: Our Pharmacy Team is committed to providing consistent, compassionate, local support.

Preferred Biosimilar Products

Erythropoiesis-Stimulating-Agents (ESA) &

Granulocyte Colony-Stimulating Factors (C-GSFs)

Preferred Biosimilar Products

Effective June 1, 2019, Retacrit® (epoetin alfa-epbx) will be the preferred erythropoiesis-stimulating agent (ESA) on the CenCal Health Formulary. Epogen® and Procrit® will be removed from the CenCal Health formulary and will require a prior authorization indicating a trial/failure of the preferred ESA product.

Effective June 1, 2019, Zarxio® (filgrastim-sndz), Nivestym® (fligrastim-aafi), Fulphila® (pegfilgrastim-jmdb) and Udenyca® (pegfilgrastim-sbqv) will be the preferred Granulocyte Colony-Stimulating Factors (C-GSFs) on the CenCal Health Formulary. Neupogen® and Neulasta® will be removed from the CenCal Health formulary and will require a prior authorization indicating a trial/failure of the preferred C-GSF product.

Biosimilar Facts:

  • Biosimilars are biologic medicines that are highly similar to their reference biologic, demonstrating no clinically meaningful differences in safety, purity, and potency comparted to that of the reference product.
  • All Biosimilar Products have been approved by the FDA
  • Biosimilars are not interchangeable with the reference products and will require a new prescription from the prescriber

Please contact CenCal Health Pharmacy Department with questions at (805) 562-1080

Opioid Updates 2019

Opioid and Benzodiazepine Concomitant Use Safety Edit

With the approval of CenCal Health's Pharmacy and Therapeutics Committee and in coordination with its Pharmacy Benefits Manager (MedImpact), CenCal Health continues to implement a multi-phase plan to deter over-utilization of opioids, and update utilization management measures.

Effective 9/1/2019, CenCal Health will implement an opioid and benzodiazepine concomitant use safety edit. The safety edit is a point of sale (POS) intervention that will identify and deny concurrent use of opioids and benzodiazepines when there is any overlap in the day supply. Interventions will work bi-directionally and stop claims when there is an opioid-benzodiazepine claim overlap or vice versa. 

In order to override these rejections, the pharmacist may conduct a Drug Utilization Review (DUR) and submit the applicable override that outlines the specific actions taken by the pharmacist. The dispensing pharmacist can bypass the soft edit by using the following overrides: 

4C (Hospice) 1A (Filled As Is, False Positive)
4B (Palliative Care) 1B (Filled As Is, Not Relevant) 
4D (Cancer)  4A (Prescribed with Acknowledgements)
1G (Prescriber Approval) 3G (Drug Therapy Unchanged)

During the month of August, benzodiazepine prescribers who hit the edit described above will receive an outreach letter. The letter will provide the prescriber with a list of their CenCal Health members who are currently taking an opioid and benzodiazepine. Resources around the use of benzodiazepines will be provided in the letter, including the option for a personalized consultation to discuss custom tapering recommendations or alternative treatment choices. Additional pain management resources are also available through CenCal Health on the Pharmacy Pain Management Resources page. 

If you have questions or need additional information, please contact the CenCal Health Pharmacy Department at (805) 562-1080.

2019 Formulary Updates